Provider Demographics
NPI:1639623820
Name:GOING PLACES
Entity Type:Organization
Organization Name:GOING PLACES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:VANDAMME
Authorized Official - Suffix:
Authorized Official - Credentials:QIDP
Authorized Official - Phone:775-342-7323
Mailing Address - Street 1:5365 MAE ANNE AVE STE A10
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-1841
Mailing Address - Country:US
Mailing Address - Phone:775-342-7323
Mailing Address - Fax:775-323-6263
Practice Address - Street 1:5365 MAE ANNE AVE STE A10
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-1841
Practice Address - Country:US
Practice Address - Phone:775-342-7323
Practice Address - Fax:775-323-6263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1699135335Medicaid